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November 11, 2014 / molehunter

Mole of mixed colour

This 6mm lesion was noted on the upper arm of a 60 something white person. Concern was expressed as colour was mixed.

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There is mixed colour distributed somewhat irregularly. This feature may cause legitimate concern. Let’s do dermoscopy.

???????????????????????????????The colour now looks less mixed. I can see no colour other than brown, albeit variegated. Different shades of brown is not the same as mixed colour in my book. The colour here is mainly contained in globules which vary in size but broadly speaking are bigger near the centre of the lesion and smaller towards the periphery. Melanin causes different shades of brown depending on how deep it is in the epidermis. If there was black, blue, red or grey it would be another story.

I should also mention that there was no history of skin cancer, no history of recent change, and the mole felt soft and wobbly. All very reassuring.

This is a benign dermal/compound naevus. No need to waste resources and give someone a scar for this, there just is not enough wrong with it to justify excision. I always try to advise patients on what signs of malignant skin lesions are and advise them to seek further advice if they see significant change.

learning point-yes there is not perfect symmetry, there almost never is. But taking a balanced view of colour, shape and structure, this mole is as symmetrical as can reasonably be expected. When beginning and improving with the dermoscope, the learner should study hundreds of lesions about which there is no clinical concern in order to gain a mental picture of the limits of the normal. It is not ethical to excise large numbers of lesions which are believed to be benign just to prove they are for teaching purposes. That work has already been done.

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